Towards an outcome documentation in manual medicine: a first proposal of the International Classification of Functioning, Disability and Health (ICF) intervention categories for manual medicine based on a Delphi survey

AIM

The International Classification of Functioning, Disability and Health (ICF) provides a useful framework for the comprehensive description of the patients' functional health. The aim of this study was to identify the ICF categories that represent the patients' problems treated by manual medicine practitioners in order to facilitate its application in manual medicine. This selection of ICF categories could be used for assessment, treatment documentation and quality management in manual medicine practice.

METHODS

Swiss manual medicine experts were asked about the patients' problems commonly treated by manual medicine practitioners in a three-round survey using the Delphi technique. Responses were linked to the ICF.

RESULTS

Forty-eight manual medicine experts gave a total of 808 responses that were linked to 225 different ICF categories; 106 ICF categories which reached an agreement of at least 50% among the participants in the final Delphi-round were included in the set of ICF Intervention Categories for Manual Medicine; 42 (40%) of the categories are assigned to the ICF component body functions, 36 (34%) represent the ICF component body structures and 28 (26%) the ICF component activities and participation.

CONCLUSION

A first proposal of ICF Intervention Categories for Manual Medicine was defined and needs to be validated in further studies.

The quality of spine surgery from the patient's perspective. Part 1: the Core Outcome Measures Index in clinical practice

The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument, with excellent psychometric properties, that has been recommended for use in monitoring the outcome of spinal surgery from the patient's perspective. This study examined the feasibility of implementation of COMI and its performance in clinical practice within a large Spine Centre. Beginning in March 2004, all patients undergoing spine surgery in our Spine Centre (1,000-1,200 patients/year) were asked to complete the COMI before and 3, 12 and 24 months after surgery. The COMI has one question each on back (neck) pain intensity, leg/buttock (arm/shoulder) pain intensity, function, symptom-specific well being, general quality of life, work disability and social disability, scored as a 0-10 index. At follow-up, patients also rated the global effectiveness of surgery, and their satisfaction with their treatment in the hospital, on a five-point Likert scale. After some fine-tuning of the method of administration, completion rates for the pre-op COMI improved from 78% in the first year of operation to 92% in subsequent years (non-response was mainly due to emergencies or language or age issues). Effective completion rates at 3, 12 and 24-month follow-up were 94, 92 and 88%, respectively. The 12-month global outcomes (from N = 3,056 patients) were operation helped a lot, 1,417 (46.4%); helped, 860 (28.1%); helped only little, 454 (14.9%); did not help, 272 (8.9%); made things worse, 53 (1.7%). The mean reductions in COMI score for each of these categories were 5.4 (SD2.5); 3.1 (SD2.2); 1.3 (SD1.7); 0.5 (SD2.2) and -0.7 (SD2.2), respectively, yielding respective standardised response mean values ("effect sizes") for each outcome category of 2.2, 1.4, 0.8, 0.2 and 0.3, respectively. The questionnaire was feasible to implement on a prospective basis in routine practice, and was as responsive as many longer spine outcome questionnaires. The shortness of the COMI and its multidimensional nature make it an attractive option to comprehensively assess all patients within a given Spine Centre and hence avoid selection bias in reporting outcomes.

Consensus Statement on Concussion in Sport – the 3rd International Conference on Concussion in Sport held in Zurich, November 2008

No Abstract.

Consensus Statement on Concussion in Sport – the 3rd International Conference on Concussion in Sport held in Zurich, November 2008

No Abstract.

Consensus statement on concussion in sport - the Third International Conference on Concussion in Sport held in Zurich, November 2008

This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport. The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document under the "background" section (see Section 11). This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite, or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving, and therefore management and return-to-play (RTP) decisions remain in the realm of clinical judgment on an individualized basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card, and neither is subject to any copyright restriction. The authors request, however, that the document and/or the SCAT2 card be distributed in their full and complete format.

The F-MARC study on Ramadan and football: research design, population, and environmental conditions

Ramadan is a month of penance during which Muslims take food or drink only after sunset and before the sun rises. This fast can present a considerable challenge to the Muslim athlete. Sports performance in those who observe Ramadan and those who do not has not been formally compared. Four Tunisian junior football squads participated in the study, and it was the individual's choice whether they observed the Ramadan fast. In this study, 64 players fasted while 36 players did not. Players completed daily questionnaires on perception of training difficulty before and during Ramadan. Anthropometric data were recorded 3 weeks before Ramadan, during the second and fourth weeks of Ramadan, and into the third week after Ramadan. Performance tests (sprint, leg power, agility, aerobic endurance, football-specific skills) were also measured on these test days. Nutritional intake was recorded by recall three times during each phase of the study. Haematological and biochemical analyses were performed on a 7-ml blood sample taken from each participant on each of the test days. Sweat samples were collected during a training session in the third week of Ramadan, when heart rate was also measured. The data analyses are presented and discussed elsewhere in this issue.

The use and abuse of painkillers in international soccer: data from 6 FIFA tournaments for female and youth players

BACKGROUND

It is known that in professional men's soccer the consumption of prescription medication is high.

PURPOSE

The intake of medication in female and adolescent male soccer players has not yet been investigated.

STUDY DESIGN

Descriptive epidemiology study.

MATERIAL

Team physicians reported 10,456 uses of medication 72 hours before each match in 2488 soccer players participating in 6 international soccer tournaments.

RESULTS

The use of a total of 6577 medical substances was reported, leading to an average intake of 0.63 substances per player per match (under-17s, 0.51; under-20s, 0.51; women, 1.0; P < or = .001 [without contraceptive medication, 0.85; P < .001]). Nonsteroidal anti-inflammatory drugs were the most commonly prescribed type of medication in all tournaments. Women's soccer had the highest percentage of players using nonsteroidal anti-inflammatory drugs per match (under-17s, 17.3%; under-20s, 21.4%; women, 30.7%; P < or = .001). Relatively few players were taking beta(2)-agonists for the treatment of asthma (under-17s, 1.3%; under-20s, 1.3%; women, 4.3%; P < or = .001).

CONCLUSION

These findings highlight the existing problem of excessive medication use in international top-level women's and male youth soccer nearly to the same extent as in men's soccer. Further steps need to be taken to understand the rationale underlying the sports physicians' practice and to plan educational programs to avoid the abuse of prescription medication.

CLINICAL RELEVANCE

Continued abuse of medication may otherwise not only negatively influence the quality of the game but also the health status of the players.

Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial

OBJECTIVE

To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football.

DESIGN

Cluster randomised controlled trial with clubs as the unit of randomisation.

SETTING

125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months).

PARTICIPANTS

1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group).

INTERVENTION

A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements.

MAIN OUTCOME MEASURE

Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip).

RESULTS

During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83).

CONCLUSION

Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players.

TRIAL REGISTRATION

ISRCTN10306290.

Determining exchange splitting in a magnetic semiconductor by spin-filter tunneling

A large exchange splitting of the conduction band in ultrathin films of the ferromagnetic semiconductor EuO was determined quantitatively, by using EuO as a tunnel barrier and fitting the current-voltage characteristics and temperature dependence to tunneling theory. This exchange splitting leads to different tunnel barrier heights for spin-up and spin-down electrons and is large enough to produce a near-fully spin-polarized current. Moreover, the magnetic properties of these ultrathin films (<6 nm) show a reduction in Curie temperature with decreasing thickness, in agreement with theoretical calculation [R. Schiller, Phys. Rev. Lett. 86, 3847 (2001)10.1103/Phys. Rev. Lett.86.3847].

Micro-RNAs miR125b and miR137 are frequently upregulated in response to capecitabine chemoradiotherapy of rectal cancer

There is increasing evidence that some microRNAs change their levels in reaction to xenobiotic challenge. The aim of this study was to test the possible involvement of micro-RNAs in response to standard anticancer treatment. Tumor biopsies from 35 patients with rectal cancer before therapy and parallel tumor biopsies from 31 patients two weeks after starting preoperative capecitabine chemoradiotherapy were taken. The expression levels of single miRNA species were measured using TaqMan Micro-RNA assays after reverse transcription from isolated total RNAs. Many micro-RNAs (miR10a, miR21, miR145, miR212, miR339, miR361) responded to chemoradiotherapy in individual tumor samples, but there was profound intertumoral variability. However, other two micro-RNAs miR125b, miR137 showed a significant increase in median expression levels after starting therapy in most samples. Moreover, our results for the first time show that higher induced levels of miR125b and miR137 are associated with worse response to the therapy.

A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players

BACKGROUND

Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large.

HYPOTHESIS

A simple on-field alternative warm-up program can reduce noncontact ACL injuries.

STUDY DESIGN

Randomized controlled trial (clustered); Level of evidence, 1.

METHODS

Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons.

RESULTS

Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries).

CONCLUSION

This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

Injuries and musculoskeletal complaints in referees and assistant referees selected for the 2006 FIFA World Cup: retrospective and prospective survey

BACKGROUND

There is a considerable amount of scientific literature on football, but few studies have focused on referees, despite their key role in this sport. Existing studies focus on the physiological demands and training of referees.

PURPOSE

To analyse injuries and musculoskeletal complaints in referees and assistant referees selected for the 2006 FIFA World Cup.

STUDY DESIGN

Retrospective survey and prospective study.

METHODS

During the preparation camps for the 2006 FIFA World Cup in Germany, all 123 referees pre-selected for the tournament completed a questionnaire on injuries and musculoskeletal complaints. During the tournament, the characteristics and consequences of all injuries and complaints incurred by the 63 officiating referees were documented.

RESULTS

More than 40% of the referees reported having incurred an injury and more than 60% having had musculoskeletal complaints during their career. About 20% of the group reported having suffered from musculoskeletal complaints in the last match. During the World Cup, 14 referees (22%) incurred an injury and more than 30% had musculoskeletal complaints. This prospectively collected data showed an incidence of 20.8 injuries per 1000 match hours (95% CI: 4.17 to 37.4). The most common acute injuries were hamstring strains, calf strains, and ankle sprains, while the most frequent locations of complaints were the low back, hamstring and knee.

CONCLUSION

Considering the injury profile, the prevalence of associated musculoskeletal complaints, and the high physiological demands of refereeing, it appears that injury prevention programmes should be developed and integrated into the fitness training routine of the referee.

Observation of the 3n evaporation channel in the complete hot-fusion reaction 26Mg + 248Cm leading to the new superheavy nuclide 271Hs

The analysis of a large body of heavy ion fusion reaction data with medium-heavy projectiles (6 < or = Z < or = 18) and actinide targets suggests a disappearance of the 3n exit channel with increasing atomic number of the projectile. Here, we report a measurement of the excitation function of the reaction (248)Cm ((26)Mg,xn)(274-x)Hs and the observation of the new nuclide (271)Hs produced in the 3n evaporation channel at a beam energy well below the Bass fusion barrier with a cross section comparable to the maxima of the 4n and 5n channels. This indicates the possible discovery of new neutron-rich transactinide nuclei using relatively light heavy ion beams of the most neutron-rich stable isotopes and actinide targets.

The use of medication and nutritional supplements during FIFA World Cups 2002 and 2006

Objective:

To examine medication use in male top-level football players prior to and during international tournaments.

Design:

Prospective survey.

Material:

2944 team physicians’ reports on players’ medication intake.

Methods:

Each team physician was asked to document all medication and nutritional supplements taken in the 72 h prior to each match.

Results:

A total of 10 384 substances were reported (1.8 substances/player/match); 4450 (42.9%) of these were medicinal and 5934 (57.1%) nutritional supplements. The medications prescribed most frequently were non-steroidal anti-inflammatory agents (n = 2092; 20.1%); more than half of the players took these at least once during a tournament and more than 10% prior to every match (156 out of 1472). β-2-Agonists were reported for 1.4% (n = 20) and inhaled corticosteroids for 1.6% (n = 23) of participating players. Injected corticosteroids were reported for 73 players.

Conclusions:

The high intake of medication in international football – especially of non-steroidal anti-inflammatory drugs – is alarming and should be addressed. The results raise questions as to whether the medication was taken solely for therapeutic reasons. In view of the potential side effects, more restrictive recommendations for sport need to be developed.

The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients

A prospective study of 1,017 patients who received MIOM during spine surgery procedures between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve roots function during spine surgery. MIOM has become a widely used method of monitoring neural function during spine surgery. Several techniques only monitor either ascending or descending pathways and thus may not provide sensitive or specific results. MIOM aims to monitor both ascending and descending pathways therefore giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative sensory spinal and cortical evoked potentials, combined with monitoring of EMG and motor evoked potentials recorded from the spinal cord and muscles elicited by electrical motor cortex, spinal cord, cauda equina and nerve root stimulation, was evaluated and compared with post-operative clinical neurological changes. One thousand and seventeen consecutive patients underwent a total of 4,731 h of MIOM to evaluate any neural deficits that may have occurred during spine surgery. Of these, 935 were true negative cases, 8 were false negative cases, 66 were true positive cases and 8 were false positive cases, resulting in a sensitivity of 89% and a specificity of 99%. Based on the results of this study, MIOM is an effective method of monitoring the spinal cord functional integrity during spine surgery and therefore can lead to reduction of neurological deficit and consequently improve postoperative results.

Multimodal intraoperative monitoring: an overview and proposal of methodology based on 1,017 cases

To describe different currently available tests of multimodal intraoperative monitoring (MIOM) used in spine and spinal cord surgery indicating the technical parameters, application and interpretation as an easy understanding systematic overview to help implementation of MIOM and improve communication between neurophysiologists and spine surgeons. This article aims to give an overview and proposal of the different MIOM-techniques as used daily in spine and spinal cord surgery at our institution. Intensive research in neurophysiology over the past decades has lead to a profound understanding of the spinal cord, nerve functions and their intraoperative functional evaluation in anaesthetised patients. At present, spine surgeons and neurophysiologist are faced with 1,883 publications in PubMed on spinal cord monitoring. The value and the limitations of single monitoring methods are well documented. The diagnostic power of the multimodal approach in a larger study population in spine surgery, as measured with sensitivity and specificity, is dealt with elsewhere in this supplement (Sutter et al. in Eur Spine J Suppl, 2007). This paper aims to give a detailed description of the different modalities used in this study. Description of monitoring techniques of the descending and ascending spinal cord and nerve root pathways by motor evoked potentials of the spinal cord and muscles elicited after transcranial electrical motor cortex, spinal cord, cauda equina and nerve root stimulation, continuous EMG, sensory cortical and spinal evoked potentials, as well as direct spinal cord evoked potentials applied on 1,017 patients. The method of MIOM, continuously adapted according to the site, stage of surgery and potential danger to nerve tissues, proved to be applicable with online results, reliable and furthermore teachable.

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal- and cortical-evoked potentials, combined with continuous EMG- and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented true-negative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results.

Tackle mechanisms and match characteristics in women's elite football tournaments

BACKGROUND

Several tools have been used for assessing risk situations and for gathering tackle information from international football matches for men but not for women.

PURPOSE

To analyse activities in women's football and to identify the characteristics and risk potentials of tackles.

STUDY DESIGN

Retrospective video analysis.

METHOD

Video recordings of 24 representative matches from six women's top-level tournaments were analysed for tackle parameters and their risk potential.

RESULTS

3531 tackles were recorded. Tackles in which the tackling player came from the side and stayed on her feet accounted for nearly half of all challenges for the ball in which body contact occurred. 2.7% of all tackles were classified as risk situations, with sliding-in tackles from behind and the side having the highest risk potential. Match referees sanctioned sliding-in tackles more often than other tackles (20% v 17%, respectively). Tackle parameters did not change in the duration of a match; however, there was an increase in the number of injury risk situations and foul plays towards the end of each half.

CONCLUSIONS

Match properties provide valuable information for a better understanding of injury situations in football. Staying on feet and jumping vertically tackle actions leading to injury were sanctioned significantly more times by the referee than those not leading to injury (p<0.001), but no such difference was seen for sliding-in tackles (previously reported to have the highest injury potential in women's football). Therefore, either the laws of the game are not adequate or match referees in women's football are not able to distinguish between sliding-in tackles leading to and those not leading to injury.

A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine

Spinal decompression is the most common type of spinal surgery carried out in the older patient, and is being performed with increasing frequency. Physiotherapy (rehabilitation) is often prescribed after surgery, although its benefits compared with no formal rehabilitation have yet to be demonstrated in randomised control trials. The aim of this randomised controlled trial was to examine the effects on outcome up to 2 years after spinal decompression surgery of two types of postoperative physiotherapy compared with no postoperative therapy (self-management). Hundred and fifty-nine patients (100 men, 59 women; 65 +/- 11 years) undergoing decompression surgery for spinal stenosis/herniated disc were randomised to one of the following programmes beginning 2 months post-op: recommended to "keep active" (CONTROL; n = 54); physiotherapy, spine stabilisation exercises (PT-StabEx; n = 56); physiotherapy, mixed techniques (PT-Mixed; n = 49). Both PT programmes involved 2 x 30 min sessions/week for up to 12 weeks, with home exercises. Pain intensity (0-10 graphic rating scale, for back and leg pain separately) and self-rated disability (Roland Morris) were assessed before surgery, before and after the rehabilitation phase (approx. 2 and 5 months post-op), and at 12 and 24 months after the operation. 'Intention to treat' analyses were used. At 24 months, 151 patients returned questionnaires (effective return rate, excluding 4 deaths, 97%). Significant reductions in leg and back pain and self-rated disability were recorded after surgery (P < 0.05). Pain showed no further changes in any group up to 24 months later, whereas disability declined further during the "rehabilitation" phase (P < 0.05) then stabilised, but with no significant group differences. 12 weeks of post-operative physiotherapy did not influence the course of change in pain or disability up to 24 months after decompression surgery. Advising patients to keep active by carrying out the type of physical activities that they most enjoy appears to be just as good as administering a supervised rehabilitation program, and at no cost to the health-care provider.

Head injuries in the female football player: incidence, mechanisms, risk factors and management

Although all injuries in sports are a concern for participants, head injuries are particularly troublesome because of the potential for long-term cognitive deficits. To prevent any specific injury, it is important to understand the basic frequency and incidence of injury and then the mechanism of injury. Once these are established, prevention programmes can be tested to see if the rate of injury changes. A primary problem with head injuries is recognising that the injury has occurred. Many athletes are not aware of the seriousness of concussive injury, thus this type of injury is probably under-reported. Once the diagnosis of a concussion is made, the next difficult decision is when to return a player to the game. These two management issues dominate the continuing development of understanding of concussive head injury. This paper explores the known gender differences between head injuries and highlights the areas that need to be considered in future research.

Injuries in female football players in top-level international tournaments

BACKGROUND

Despite the growing popularity of women's football and the increasing number of female players, there has been little research on injuries sustained by female football players.

PURPOSE

Analysis of the incidence, characteristics and circumstances of injury in elite female football players in top-level international tournaments.

STUDY DESIGN

Prospective survey.

METHODS

Injuries incurred in seven international football tournaments were analysed using an established injury report system. Doctors of all participating teams reported all injuries after each match on a standardised injury reporting form. The mean response rate was 95%.

RESULTS

387 injuries were reported from 174 matches, equivalent to an incidence of 67.4 injuries/1000 player hours (95% CI 60.7 to 74.1) or 2.2 injuries/match (95% CI 2.0 to 2.4). Most injuries (84%; 317/378) were caused by contact with another player. The injuries most commonly involved the lower extremity (n = 248; 65%), followed by injuries of the head and neck (n = 67, 18%), trunk (n = 33, 9%) and upper extremity (n = 32, 8%). Contusions (n = 166; 45%) were the most frequent type of injury, followed by sprains or ligament rupture (n = 96; 26%) and strains or muscle fibre ruptures (n = 31; 8%). The most common diagnosis was an ankle sprain. There were 7 ligament ruptures and 15 sprains of the knee. On average 1 injury/match (95% CI 0.8 to 1.2) was expected to result in absence from a match or training.

CONCLUSION

The injury rate in women's top-level tournaments was within the range reported previously for match injuries in elite male and female players. However, the diagnoses and mechanisms of injury among the female players differed substantially from those previously reported in male football players.